<!DOCTYPE html>
<html lang="en">
    <head>
        <meta charset="UTF-8">
        <meta name="viewport" content="width=device-width,initial-scale=1.0">
        <meta http-equiv="X-UA-Compatible" content="ie=edge">
        <script type="text/javascript" src="../My97DatePickerBeta/WdatePicker.js"></script>
        
        <title>电子申请单</title>
        
    </head>
    <body style="background: #f0f2f5;">

        <div class="header_cy clearfix">
            <div class="logoName_cy fl">
                <img src="./images/smalllogo.png" alt="" width="30px">
                <span>岱嘉医学影像云服务平台</span>
            </div>
            <div class="powerBtn_cy fr"></div>
            <div class="password_cy fr"></div>
            <div class="userInfo_cy fr clearfix">
                <span class="fr userName_cy">张医生</span>
                <img class="fr" src="./images/u879.png" alt="" width="30px">
            </div>
        </div>
    
        <div class="content_zn clearfix">
    
            <div class="leftBtns_chq fl">
                <div class="appointment_chq js_app_chq">
                    <span class="addIcon_chq">+</span>
                    <span>预约登记</span>
                </div>
                <ul class="leftTabs_chq">
                    <li class="leftTabs_ac_chq">电子申请单</li>
                    <li>已登记病人</li>
                    <li>机房检查</li>
                </ul>
            </div>
    
            <div class="rightTable_zn fl">
    
                <div class="title_chq">电子申请单</div>
                <div class="shearchRow_chq">
    
    
                    <!-- <div class="cosSelectBox_chq js_daySelect marginR10" style="width:50px;">
                        <span class="cosSpan_chq">今天</span>
                        <div class="cosTool_chq">
                            <span class="cosSpanImg_chq downImg_chq"></span>
                        </div>
                        <div class="cosSelect_chq">
                            <div class="cosSelectCon_chq" >
                                <ul>
                                    <li>昨天</li>
                                    <li>明天</li>
                                </ul>
                            </div>
                        </div>
                    </div> -->
                    
    
                    <input type="text" class="calder_chq is_startTime" onclick="WdatePicker({dateFmt:'yyyy-MM-dd',isShowOK:'true'})" value="2020-10-26"/>
                        <span>至</span>
                    <input type="text" class="calder_chq is_endTime marginR10" onclick="WdatePicker({dateFmt:'yyyy-MM-dd',isShowOK:'true'})" value="2020-11-26"/>
                    
                      
                    <div class="cosSelectBox_chq js_clinicTypeSelect marginR10" style="width:75px;">
                        <!-- <span class="cosSpan_chq js_type_chq">病人类型</span> -->
                        <span class="cosSpan_chq js_type_chq">门诊</span>
                        <div class="cosTool_chq">
                            <span class="cosSpanImg_chq downImg_chq"></span>
                        </div>
                        <div class="cosSelect_chq">
                            <div class="cosSelectCon_chq" >
                                <ul>
                                    <li>门诊</li>
                                    <li>住院</li>
                                    <li>急诊</li>
                                    <li>体检</li>
                                </ul>
                            </div>
                        </div>
                    </div>
    
                    <div class="cosSelectBox_chq js_patientNameSelect" style="width:75px;">
                        <!-- <span class="cosSpan_chq js_queryContentType_chq">查询类型</span> -->
                        <span class="cosSpan_chq js_queryContentType_chq">姓名</span>
                        <div class="cosTool_chq">
                            <span class="cosSpanImg_chq downImg_chq"></span>
                        </div>
                        <div class="cosSelect_chq">
                            <div class="cosSelectCon_chq" >
                                <ul>
                                    <li>姓名</li>
                                    <li>病人号</li>
                                    <li>身份证号</li>
                                    <li>体检号</li>
                                </ul>
                            </div>
                        </div>
                    </div>
                    <input type="text" name="" class="imageInput_chq marginR10 js_queryContent_chq" value="崔惠惠">
                    <span class="btn js_search_chq">搜索</span>
                </div>
    
                <div class="tableBox_chq">
                    <div class="layer_chq">
                        <table></table>
                        <img class="loading_chq" src="images/loading.gif"></img>
                    </div>
                </div>
             
                
                <div class="bottomBtns_chq clearfix">
                    <!-- 表格每页几行 -->
                    <div class="cosSelectBox_chq js_pageNumSelect" style="width:20px;">
                        <span class="cosSpan_chq js_pageSize_chq">15</span>
                        <div class="cosTool_chq">
                            <span class="cosSpanImg_chq downImg_chq"></span>
                        </div>
                        <div class="cosSelect_chq">
                            <div class="cosSelectCon_chq" >
                                <ul>
                                    <li>15</li>
                                    <li>20</li>
                                    <li>50</li>
                                </ul>
                            </div>
                        </div>
                    </div>
                    <!-- 跳转按钮组 -->
                    <div class="fr pageBtns_chq">
                        <span class="prev_chq"><</span>
                        <span class="pageNumber_chq">
                            <i class="js_nowPage_chq">1</i>/<i class="js_totalPage_chq">1</i>
                        </span>
                        <span class="next_chq">></span>
                        <span class="goto_chq">
                            <input type="text" name="" id="" class="js_gotoInput_chq">
                            <span class="gotoBtn_chq">跳转</span>
                        </span>
                    </div>
                    
                </div>
    
                <div class="tipsBox_zn">
                    <span class="tipText_zn">
                        <span class="toCheck_OPC"></span>
                        <span>门诊检查病人</span>
                    </span>
                    <span class="tipText_zn">
                        <span class="toCheck_ER"></span>
                        <span>急诊检查病人</span>
                    </span>
                    <span class="tipText_zn">
                        <span class="toCheck_IP"></span>
                        <span>住院检查病人</span>
                    </span>
                    <span class="tipText_zn">
                        <span class="toCheck_HE"></span>
                        <span>体检检查病人</span>
                    </span>
                    
                </div>
    
            </div>
        </div>
    
        <!-- 预约申请弹出框1 -->
        <div class="popBox_chq js_addForm_chq">
            <div class="m-listDiv_zn">
                <div class="s-text1_zn">
                    <span class="s-textTitle_zn" >合并/拆分申请单</span>
                    <div class="s-tip_zn">
                        <img src="images/u402.png" alt="">
                        <span class="s-textTip_zn">系统检测到该患者多份电子申请单，是否要合并/拆分预约登记？</span>
                    </div>
                    <img class="m-shape3_zn js_addFormClose_chq" src="images/u363.png" alt="">
                </div>
                <div class="s-text2_zn">
                    <span>请选择需要预约登记的申请单</span>
                </div>
                <div class="m-requisitionList_zn clearfix">
                </div>
                <div class="u-butList_zn">
                    <a href="#"><button class="u-butNext_zn js_nextPop_chq">下一步</button></a>
                    <a href="#"><button class="u-butCancel_zn js_addFormCacle_chq">取&nbsp;消</button></a>
                </div>
            </div>
        </div>
        
        <!-- 预约登记弹出框2 -->
        <div class="popBox_chq js_appRegister_chq">
            <div class="m_min_zn">
                <div class="m_header_zn">
                    <div class="s_preregist_zn">
                        <span>预约登记</span>
                        <div class="m_shape1_zn">
                            <!-- <img class="m-shape3_zn js_addFormClose_chq" src="images/u363.png" alt=""> -->
                            <img src="images/u363.png" alt="" class="is_close_appRegister">
                        </div>
                    </div>
                    <div class="clearfix"> 
                        <div class="s_imageNo_zn">
                            <span>影像号：</span>
                            <span class="js_risPatientId_chq"></span>
                            <!-- <input type="text"> -->
                        </div>
    
                        <div class="right_zn">
                            <div class="delete_zn">
                                <span>清空(Del)</span>
                            </div>
                            <div class="read_zn">
                                <span>读卡(F3)</span>
                            </div>
                            <div class="toLead_zn">
                                <span>导入</span>
                            </div>
                            <input type="text" class="imageNo_zn">
                            <div class="imageNoDiv_zn">
                                <span>影像号</span>
                                <img src="images/指示器_u47.png" alt="">
                            </div>
                        </div>
                    </div>
                </div>
        

                <div class="information_zn">
                    <div class="patient_zn">
                        <span>患者信息</span>
                    </div>
        

                    <div class="leftInformation_zn clearfix">
                        <div class="informationDiv_zn fl">
                            <span><i style="color: red;">*</i>患者姓名 :</span>
                            <input type="text" class="js_patientName_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span><i style="color: red;">*</i>姓名拼音 :</span>
                            <input type="text" class="js_pingyin_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span class=""><i style="color: red;">*</i>性别 :</span>
                            <div class="sexDiv">
                                <div class="sex" data-sex="M">
                                    <img src="images/u161.png" alt="">
                                    <i>男</i>
                                </div>
                                <div class="sex" data-sex="F">
                                    <img src="images/u165.png" alt="">
                                    <i>女</i>
                                </div>
                            </div>
                        </div>

                        <div class="informationDiv_zn fl">
                            <span>身份证号 :</span>
                            <input type="text" class="js_idcard_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span><i style="color: red;">*</i>出生日期 :</span>
                            <input type="text" class="js_birthday_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>出生时间 :</span>
                            <p style="display: inline-block;padding-right: 5px;">
                                <input type="text" style="width: 54px;border: none;" class="js_hour_chq">
                                <i>时</i>
                                <input type="text" style="width: 54px;border: none;" class="js_min_chq">
                                <i style="margin-left:-5px;">分</i>
                            </p>
                        </div>
                        <div class="informationDiv_zn fl" style="position: relative;">
                            <span>体重 :</span>
                            <input type="text" class="js_weight_chq">
                            <i style="position: absolute;right: 20px;top: 5px;">kg</i>
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>医保卡号 :</span>
                            <input type="text" class="js_medicareCardNumber_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>自费卡号 :</span>
                            <input type="text" class="js_selfPayCardNumber_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>手机号 :</span>
                            <input type="text" class="js_phoneNumber_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>家属电话 :</span>
                            <input type="text" class="js_familyPhone_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>工作单位 :</span>
                            <input type="text" class="js_company_chq">
                        </div>
                        <div class="informationDiv_zn fl">
                            <span>联系地址 :</span>
                            <input type="text" style="width: 406px;" class="js_address_chq">
                        </div>
                    </div>
                </div>
        
                <div class="medical_zn">
                    <div class="medicalRight">
                        <div class="medical_text">
                            <span>病历信息</span>
                        </div>
        
                        <div class="patientType">
                            <div class="patient">
                                <span>病人类型 :</span>
                            </div>
                            <div class="patient_type patient_type_ac" data-patientType="0">
                                门诊
                            </div>
                            <div class="patient_type" data-patientType="1">
                                住院
                            </div>
                            <div class="patient_type" data-patientType="2">
                                体检
                            </div>
                        </div>
        
                         <div class="urgencyDiv clearfix">
                             <div class="urgency">
                                紧急程度 :
                             </div>
                             <div class="urgency_item marginR15 urgency_item_selected" data-emergencyId="1">
                                 普通
                             </div>
                             <div class="urgency_item" data-emergencyId="2">
                                 急症
                             </div>
                         </div>
        
                         <div class="inHospital clearfix">
                             <div class="inPosNo">
                                 <span style="margin-right: 24px;">住院号:</span>
                                 <input type="text" class="js_patientNumber_chq">
                             </div>
                             <div class="admission">
                                 <span>住院次数:</span>
                                 <input type="text" class="js_hospitalizedNumber_chq">
                             </div>
                             <div class="inpatient_ward">
                                 <span>病区:</span>
                                 <input type="text" class="js_ward_chq">
                             </div>
                             <div class="bed_number">
                                 <span>床号:</span>
                                 <input type="text" class="js_bedNo_chq">
                             </div>
                         </div>
        
                         <div class="informationRight">
                             <div class="billing_hosDiv">
                                <span>开单医院：</span>
                                <div class="cosSelectBox_chq js_hospitalSelect" style="width:128px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                            </ul>
                                        </div>
                                    </div>
                                </div>

                             </div>
        
                             <div class="billing_depDiv">
                                <span>开单科室：</span>
                                <div class="cosSelectBox_chq js_reqDeptSelect" style="width:128px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                            </ul>
                                        </div>
                                    </div>
                                </div>
                             </div>
                             
                             <div class="case_desDiv">
                                <span>病历描述：</span>
                                <div class="case_des">
                                    <textarea name="" id="" cols="17" rows="5" class="js_medicalRecordDescription_chq"></textarea>
                                </div>
                             </div>
                         </div>
                         <div class="informationLeft">
        
                            <div class="inspect_depDiv">
                                <span>检查科室：</span>
                                <div class="cosSelectBox_chq js_checkDept" style="width:128px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                            </ul>
                                        </div>
                                    </div>
                                </div>
                            </div>
        
                            <div class="billing_dcDiv">
                               <span>开单医生：</span>
                               <div class="cosSelectBox_chq js_reqDoctorSelect" style="width:128px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>

                                            </ul>
                                        </div>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="clicinal_diagnosDiv">
                               <span>临床诊断：</span>
                               <div class="clicinal_diagnos">
                                   <textarea name="" id="" cols="17" rows="5" class="js_clinicDiagnose_chq"></textarea>
                               </div>
                            </div>
                         </div>
                    </div>
        
                    <div class="medicalLeft">
                        <div class="medical_text2">
                            <span>病历信息</span>
                        </div>
                        <div class="typeList">
                            
                            <div class="check_typeDiv">
                                <span>检查类型：</span>
                                <div class="cosSelectBox_chq js_checkType" style="width:50px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                            </ul>
                                        </div>
                                    </div>
                                </div>
                             </div>
        
                             <div class="inspect_eupDiv">
                                <span>检查设备：</span>
                                <div class="cosSelectBox_chq js_checkModality" style="width:50px;">
                                    <span class="cosSpan_chq">请选择</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                            </ul>
                                        </div>
                                    </div>
                                </div>
                             </div>
        
                             <div class="report_typeDiv">
                                <span>报告类型：</span>
                                <div class="cosSelectBox_chq js_reportType" style="width:50px;">
                                    <span class="cosSpan_chq">普通报告</span>
                                    <div class="cosTool_chq">
                                        <span class="cosSpanImg_chq downImg_chq"></span>
                                    </div>
                                    <div class="cosSelect_chq">
                                        <div class="cosSelectCon_chq" >
                                            <ul>
                                                <li data-key="0">普通报告</li>
                                                <li data-key="1">精准报告</li>
                                                <li data-key="2">精准报告（补发）</li>
                                            </ul>
                                        </div>
                                    </div>
                                </div>
                             </div>
                            
                        </div>
        
                        <div class="optionalDiv">
                            <div>可选部位/方法:</div>
                            <div class="selectedList">
                                <div class="shearch_input_chq">
                                    <input type="input" name="" id="" placeholder="简码搜索" class="js_fastKeyInput">
                                    <img src="images/u359.png" alt="" class="searchIcon">
                                </div>
                                <div class="methoBox_chq"></div>
                            </div>
                        </div>
        
                        <div class="selectedDiv">
                            <div class="selected_zn">
                                <span>已选部位||方法：</span>
                            </div>
                            <div class="selectedList Methods_list" style="overflow: auto;height: 170px;">
                                    <!-- <li class="selected_item">
                                        <img src="images/close_small.png">
                                        <span>
                                            颅脑|平扫|LN
                                        </span>
                                        
                                    </li>
                                    <li class="selected_item">
                                        <img src="images/close_small.png">
                                        <span>
                                            颅脑|平扫|LN
                                        </span>
                                        
                                    </li> -->
                            </div>
                        </div>
                    </div>
                </div>
        
                <div class="button_zn clearfix">
                    <div class="submitApp">
                        <input type="submit" value="提交申请" class="js_submit_chq">
                    </div>
                    <div class="cancelRegist">
                        <input type="submit" value="取消登记" class="is_cacle_appRegister">
                    </div>
                </div>
            </div>
        </div>


        <div class="mask_chq"></div>
        <script src="http://192.168.130.85:3317/test.js"></script>
        <!-- <script src="./js/api.js"></script> -->
    </body>

</html>
